Hospital Pharmacy - June 2017 - 436
436
Hospital Pharmacy 52(6)
Table 2. ACLS Compliance.
Outcome
Medication interventions compliant with ACLS guidelines, n (%)
Defibrillation interventions complaint with ACLS guidelines, n (%)
Composite of medication and defibrillation interventions
compliant with ACLS guidelines, n (%)
Resuscitations without any deviation from ACLS guidelines, n (%)
Survival to hospital admission, n (%)
Survival to hospital discharge, n (%)
PharmD Present
No PharmD
P value
93 (78)
23 (68)
116 (76)
154 (67)
8 (47)
162 (65)
.0255a
.1557a
.0268a
9 (43)
8 (25)
2 (15)
14 (27)
5 (17.8)
3 (4.4)
.2000a
.0155b
.6392b
Note. ACLS = Advanced Cardiac Life Support.
a
Chi-square.
b
Fisher exact test.
Table 3. Pharmacist Interventions Documented During the
Study Period.
Category
Drug therapy consults
Drug therapy recommendation
or modifications
Drug information
Order/allergy clarification
Medical emergencies
Medication reconciliation/
patient education
ADR/allergy prevented
Other
Total
No. of
interventions
Cost avoidance
(US$)
303
193
46 359
14 977
162
163
126
99
8109
24 939
-
153
32
122
1200
3725
100
98 362
ADR = Adverse Drug Reaction.
consistent with the result by Draper and Eppert in the inpatient
setting.7 Medication-related issues, including compliance with
guideline recommendations, likely represent the largest component of the cardiac arrest resuscitation attempt that a pharmacist can have an significant impact on, as opposed to
appropriateness of defibrillations, which was not statistically
different between groups (68% vs 47%, P = .1557). Overall,
the percentage of cardiac arrest resuscitation attempts performed without any deviation from the ACLS guidelines did
increase when a pharmacist was present, though this was not
statistically significant (43% vs 27%, P = .2000). This may be
in part due to the small sample of resuscitation attempts and
other factors that the pharmacist is unlikely to have a major
impact on, like administering defibrillations in accordance
with the guideline recommendations.
Medication errors that occur during resuscitation attempts
increase both morbidity and mortality, though there is a lack of
data demonstrating an effect on these important outcomes with
the presence of a pharmacist.9 In this study, there was a statistically significant increase in survival to hospital admission
when a pharmacist was present (25% vs 17.8%, P = .0155),
though this benefit did not sustain throughout the admission,
as there was no difference in survival to hospital discharge
between groups (15% vs 4.4%, P = 0.6392). While survival to
hospital discharge is arguably the more important of these 2
endpoints, improving survival to hospital admission is a step in
the right direction. There are likely other factors including
post-cardiac arrest management that could have impacted survival in this study, so it is unclear how much of an impact the
pharmacist may have actually had on this outcome.
Cost-Effectiveness and Common Clinical Activities
There have been numerous articles over the years that have
demonstrated the ability of a clinical pharmacist to decrease
health care costs by recommending appropriate use of
medications.10-13 During the study period, the pharmacy residents completed 1200 interventions, with cost avoidance ranging from US$0 to US$214 per intervention. Some interventions
such as IV to PO conversions, discontinuing unnecessary
therapy, and starting deep vein thrombosis prophylaxis or
stress ulcer prophylaxis were not associated with cost avoidance based on the proprietary data provided by Quantifi,
though these types of interventions have been associated with
cost savings to the health care system by preventing medical
complications or selecting less expensive alternatives.14 For
the interventions that were associated with cost avoidance, we
estimated that the pharmacists in the ED avoided US$98 362
in costs during the study period, which would average to
approximately US$321 308 annually with a single full-time
pharmacist. Because not all interventions performed in this
study had an associated cost avoidance, it is likely that the true
annual cost avoidance would be higher than we estimated.
Conclusion
In this study, the inclusion of a pharmacist as a member of the
ED resuscitation team improved the quality of patient care
delivered to patients experiencing cardiac arrest by means of
improving medication compliance with ACLS guidelines.
The presence of a pharmacist on the ED resuscitation team
was also associated with a decrease in mortality, though this
needs to be explored further. Also, pharmacists in the ED can
make a substantial financial impact as well, with this study
Table of Contents for the Digital Edition of Hospital Pharmacy - June 2017
Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
ISMP Medication Error Report Analysis
Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Formulary Drug Reviews: Plecanatide
Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
Financial Effect of a Drug Distribution Model Change on a Health System
Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
Hospital Pharmacy - June 2017 - 381
Hospital Pharmacy - June 2017 - 382
Hospital Pharmacy - June 2017 - 383
Hospital Pharmacy - June 2017 - 384
Hospital Pharmacy - June 2017 - 385
Hospital Pharmacy - June 2017 - 386
Hospital Pharmacy - June 2017 - 387
Hospital Pharmacy - June 2017 - Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
Hospital Pharmacy - June 2017 - 389
Hospital Pharmacy - June 2017 - ISMP Medication Error Report Analysis
Hospital Pharmacy - June 2017 - 391
Hospital Pharmacy - June 2017 - 392
Hospital Pharmacy - June 2017 - 393
Hospital Pharmacy - June 2017 - Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Hospital Pharmacy - June 2017 - 395
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Hospital Pharmacy - June 2017 - Formulary Drug Reviews: Plecanatide
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Hospital Pharmacy - June 2017 - Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Hospital Pharmacy - June 2017 - 407
Hospital Pharmacy - June 2017 - Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
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Hospital Pharmacy - June 2017 - 410
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Hospital Pharmacy - June 2017 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
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Hospital Pharmacy - June 2017 - Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
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Hospital Pharmacy - June 2017 - Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
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